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What is ComissTM?

CoMiSSTM is an awareness tool designed to help assess potential cows’ milk allergy (CMA) in infants presenting with delayed, non-specific symptoms so earlier nutritional intervention can be considered or symptom evolution can be monitored. 1,2,3

The publication of a new pooled analysis of three prior clinical trials provides important evidence in support of CoMiSSTM as no laboratory test currently exists for non-IgE mediated CMA.

The paper was published in Pediatric Gastroenterology, Hepatology and Nutrition (March 2017). The analysis indicates that CoMiSSTM can predict the likelihood of CMA in infants exhibiting delayed non-specific symptoms with an accuracy of 75%.

The Role of ComissTM

CMA impacts between 1.4-3.5%5 of infants in the UK and can in some cases cause an immediate (IgE mediated) allergic reaction within minutes or hours. But in many cases, an infant’s reaction to milk protein is not immediate. In these non–IgE mediated cases the condition can present with delayed development of symptoms that may include excessive crying or regurgitation, stool, skin and respiratory manifestations. Because these symptoms are not specific to CMA, healthcare professionals, particularly those in primary care, may find them challenging to interpret and this can lead to delays – sometimes of several months – in therapeutic intervention.

This is where CoMiSSTM fits in. Typically it takes the primary or secondary care healthcare professional in conjunction with the parent and infant around five minutes to complete the simple and easy-to-complete CoMiSSTM scoring system. A range of scores is marked based upon the frequency and type of these non-specific symptoms. An overall score of 12 or higher helps identify infants likely to have CMA.

CoMiSSTM can also be used to quantify the evolution of symptoms to monitor therapeutic intervention.



The pooled analysis comprised 170 infants (about 3 months old) who were initially given a CoMiSSTM score of 12 or higher, and who scored below 12 (average 5) after one month on an hypoallergenic specialty formula. The analysis showed that these infants had a 75% likelihood for a positive food challenge test undertaken with cows’ milk protein when CoMiSSTM was re-scored. Non-IgE mediated CMA cannot be diagnosed by blood test and the food challenge test – which requires an elimination diet (excluding milk proteins) to be implemented – is currently the gold standard for CMA diagnosis, however it is not always performed.

Professor Yvan Vandenplas from the UZ Brussel’s Department of Pediatrics in Belgium was the leading author of the just published paper and one of the experts behind the CoMiSSTM tool. He said: ”The pooled data across three studies supports the value of CoMiSSTM as an awareness tool for CMA, as does the feedback from healthcare professionals who use it. With CoMiSSTM, primary healthcare clinicians now have an easy and fast scoring system to assess the likelihood of CMA. Symptomatic children who score 12 or higher on the CoMiSSTM score can be considered for alternative nutritional approaches much earlier in life.”

A prospective validation study is currently ongoing. CoMiSSTM is available through Nestlé Health Science in hard copy, can be downloaded from the web or completed on-line.


Developed by top international experts, CoMiSSTM (Cows’ Milk-related Symptom Score), is a fast and easy-to-use awareness tool that can aid an earlier accurate diagnosis.

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For more information on CoMiSSTM visit our HCP hub.

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Important Notice: For healthcare professionals only.

1. Vandenplas Y, Steenhout P, Planoudis Y, Grathwol D; Althera Study Group. Treating cow’s milk protein allergy: a double-blind randomized trial comparing two extensively hydrolysed formulas with probiotics. Acta Paediatr. 2013 Oct;102(10):990-8. 2. Vandenplas Y, De Greef E, Hauser B, Paradice Study Group. Safety and tolerance of a new extensively hydrolyzed rice protein-based formula in the management of infants with cow’s milk protein allergy. Eur J Pediatr. 2014;173:1209-16. 3. Vandenplas Y, De Greef E, Xinias I, Vrani O, Mavroudi A, Hammoud M, et al Allar Study Group. Safety of a thickened extensive casein hydrolysate formula. Nutrition. 2016;32:206-1Høst A. Frequency of cow’s milk allergy in childhood. Ann Allergy Asthma Immunol 2002;89(Sup1):33-7. 4. Vandenplas Y, Dupont C, Eigenmann P, Host A, Kuitunen M, Ribes-Koninckx C, et al. A workshop report on the development of the Cow’s Milk-related Symptom Score awareness tool for young children. Acta Paediatr. 2015;104:334-9. 5. Grimshaw et al. Incidence and risk factors for food hypersensitivity in UK infants: results from a birth cohort study. Clinical and Transational Allergy 2016; 6:1.